New guidance has been issued on the use of anticoagulants during the COVID-19 pandemic.
The Medicines and Healthcare products Regulatory Agency (MHRA) has issued advice for patients and healthcare professionals on monitoring of patients using warfarin and other anticoagulants during the COVID-19 pandemic. Warfarin and other anticoagulants—monitoring of patients during the COVID-19 pandemic states that supratherapeutic anticoagulation has been observed during the pandemic—an increased number of patients taking warfarin have been found to have elevated international normalised ratio (INR) values, potentially related to COVID-19 infection or antibiotic use. Healthcare professionals are advised that continued INR monitoring is important in patients taking warfarin or other vitamin K antagonists if they have suspected or confirmed COVID-19 infection to reduce the risk of bleeding. Some patients have been switched to direct oral anticoagulants (DOACs), and the MHRA warns that DOACs can interact with other medicines. Finally, the guidance advises healthcare professionals to ensure that patients are not prescribed warfarin and DOACs in error.
The American Society of Hematology (ASH) has published draft guidance on the use of anticoagulants during the COVID-19 pandemic. The draft ASH guidelines on use of anticoagulation in patients with COVID-19 features systematic reviews of the available evidence on the baseline risk of thrombosis in patients with COVID-19 and on the use of prophylactic versus higher-intensity anticoagulation in patients who are acutely or critically ill. The draft recommendations are as follows:
- the ASH guideline panel suggests using prophylactic-intensity over intermediate-intensity or therapeutic-intensity anticoagulation in patients with COVID-19-related critical illness who do not have suspected or confirmed venous thromboembolism (VTE; conditional recommendation based on very low certainty in the evidence about effects)
- the ASH guideline panel suggests using prophylactic-intensity over intermediate-intensity or therapeutic-intensity anticoagulation in patients with COVID-19-related acute illness who do not have suspected or confirmed VTE (conditional recommendation based on very low certainty in the evidence about effects).
The draft guideline will be reviewed in October and November 2020, and will be published after public review and ASH organisational review and approval.